Self-reported health-related quality of life in persons with HIV infection: results from a multi-site interview project

BACKGROUND: To examine demographic and behavioral associations with self-reported health-related quality of life (HRQOL) among persons with HIV infection or AIDS. METHODS: Analysis of interviews with persons ≥ 18 years of age reported through routine disease surveillance with HIV infection or AIDS to nine state and local health departments from January 1995 through December 1996. Scales were constructed from validated measures of HRQOL, and mean scores were calculated (lower scores signified poorer HRQOL). Measures of HRQOL included Overall Health, Pain, Physical Functioning, Role Functioning, Social Functioning, Mental Health, Energy/Fatigue, and Cognitive Functioning. Differences in HRQOL were examined by various demographic and behavioral factors, including taking antiretroviral medication. RESULTS: HRQOL data were available for 3778 persons. Factors associated with lower HRQOL scores included older age, female sex, black or Hispanic race/ethnicity, injection drug use, lower education and income, no private health insurance, and lower CD4 count. In multivariate analysis, lower CD4 count was the factor most consistently associated with lower HRQOL. Taking antiretroviral medication was not associated with differences in HRQOL regardless of CD4 count. CONCLUSIONS: Perception of HRQOL varied in a population with HIV infection or AIDS. On most HRQOL measures, lower CD4 count was associated with lower HRQOL. Measurement of HRQOL can assist in understanding the long-term effects of disease and treatment on persons with HIV

Patient and Regimen Characteristics Associated with Self-Reported Nonadherence to Antiretroviral Therapy

BACKGROUND: Nonadherence to antiretroviral therapy (ARVT) is an important behavioral determinant of the success of ARVT. Nonadherence may lead to virological failure, and increases the risk of development of drug resistance. Understanding the prevalence of nonadherence and associated factors is important to inform secondary HIV prevention efforts. METHODOLOGY/PRINCIPAL FINDINGS: We used data from a cross-sectional interview study of persons with HIV conducted in 18 U.S. states from 2000-2004. We calculated the proportion of nonadherent respondents (took <95% of prescribed doses in the past 48 hours), and the proportion of doses missed. We used multivariate logistic regression to describe factors associated with nonadherence. Nine hundred and fifty-eight (16%) of 5,887 respondents reported nonadherence. Nonadherence was significantly (p<0.05) associated with black race and Hispanic ethnicity; age <40 years; alcohol or crack use in the prior 12 months; being prescribed >or=4 medications; living in a shelter or on the street; and feeling "blue" >or=14 of the past 30 days. We found weaker associations with having both male-male sex and injection drug use risks for HIV acquisition; being prescribed ARVT for >or=21 months; and being prescribed a protease inhibitor (PI)-based regimen not boosted with ritonavir. The median proportion of doses missed was 50%. The most common reasons for missing doses were forgetting and side effects. CONCLUSIONS/SIGNIFICANCE: Self-reported recent nonadherence was high in our study. Our data support increased emphasis on adherence in clinical settings, and additional research on how providers and patients can overcome barriers to adherence

Unprotected Anal Intercourse Among HIV-Positive Men Who Have a Steady Male Sex Partner With Negative or Unknown HIV Serostatus

Objectives. We sought to determine the prevalence and predictors of unprotected anal intercourse (UAI) among HIV-positive men who have a single steady male partner with negative or unknown HIV serostatus. Methods. We analyzed behavioral surveillance data from HIV-positive men who have sex with men (MSM) interviewed in 12 states between 1995 and 2000. Results. Of 970 HIV-positive MSM who had a single steady male sex partner with negative or unknown serostatus, 278 (29%) reported UAI during the previous year. In a subset of 674 men who were aware of their infection, 144 (21%) had UAI. Among the men who were aware of their infection, factors found to be predictive of UAI in multivariate modeling were heterosexual self-identification, crack cocaine use, no education beyond high school, and a partner with unknown serostatus. Conclusions. Even after learning of their infection, one fifth of HIV-positive MSM who had a single steady male partner with negative or unknown serostatus engaged in UAI, underscoring the need to expand HIV prevention interventions among these men

Health Status, Health Care Use, Medication Use, and Medication Adherence Among Homeless and Housed People Living With HIV/AIDS

Objectives. We sought to compare health status, health care use, HIV anti-retroviral medication use, and HIV medication adherence among homeless and housed people with HIV/AIDS

Team Supervisor

All data are provisional. The HIV/AIDS Surveillance Supplemental Report is not copyrighted and may be used and copied without permission. Citation of the source is, however, appreciated

Characteristics of HIV infected persons interviewed about adherence to currently prescribed antiretroviral therapy, number and proportion of nonadherent respondents, and logistic regression model of factors associated with nonadherence among 5,887 respondents to the Supplement to HIV/AIDS Surveillance Project, 18 US States, 2000 to 2004

<p>ARVT: antiretroviral therapy; PI: protease inhibitor; HAART: Highly active antiretroviral therapy.</p>*<p>Referent group is all other races</p>†<p>Referent group is ≥40 years</p>‡<p>Confidence interval excludes 1.0; lower bound is rounded down to 1.0.</p>§<p>Referent group is all other risks</p>∥<p>Referent group is all other places of residence</p>¶<p>Any use in the 12 months before the interview</p>**<p>Referent group is duration of ARVT treatment <21 months</p>††<p>Referent group is currently prescribed 1–3 drugs</p>‡‡<p>Referent group is any other prescribed regimen</p